| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
10,825 |
10,267 |
$2.01M |
| D0120 |
Periodic oral evaluation - established patient |
10,923 |
10,641 |
$1.94M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,769 |
5,608 |
$961K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,908 |
3,513 |
$663K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,687 |
2,897 |
$522K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,345 |
1,558 |
$282K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,493 |
1,160 |
$155K |
| D2140 |
|
1,105 |
797 |
$106K |
| D5899 |
|
543 |
395 |
$81K |
| D2331 |
|
420 |
325 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
287 |
252 |
$53K |
| D1120 |
Prophylaxis - child |
9,873 |
9,578 |
$50K |
| D2330 |
|
399 |
295 |
$44K |
| D1110 |
Prophylaxis - adult |
5,555 |
5,424 |
$35K |
| D0145 |
Oral evaluation for a patient under three years of age |
122 |
122 |
$31K |
| D9110 |
|
208 |
168 |
$16K |
| D1206 |
Topical application of fluoride varnish |
11,247 |
10,929 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
8,466 |
8,101 |
$5K |
| D2332 |
|
29 |
28 |
$5K |
| D0274 |
Bitewings - four radiographic images |
6,738 |
6,555 |
$4K |
| D1351 |
Sealant - per tooth |
6,074 |
2,016 |
$3K |
| D2335 |
|
15 |
12 |
$3K |
| D0330 |
Panoramic radiographic image |
4,430 |
4,299 |
$2K |
| D2940 |
|
14 |
12 |
$2K |
| D1330 |
|
2,712 |
2,661 |
$934.29 |
| D0210 |
Intraoral - complete series of radiographic images |
1,855 |
1,804 |
$795.31 |
| D0272 |
Bitewings - two radiographic images |
2,433 |
2,360 |
$672.37 |
| D0270 |
|
2,967 |
2,854 |
$122.44 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,817 |
2,085 |
$81.54 |
| D9996 |
|
179 |
165 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
43 |
43 |
$0.00 |